Nokea
The health care provider prescribes finasteride for a patient who has benign prostatic hyperplasia (BPH). Which of the following information should the nurse include when teaching the patient about the drug?
- A. Change position from lying to standing slowly.
- B. Sexual activity interest may decrease while he is taking the medication.
- C. Improvement in the obstructive symptoms should occur within about 2 weeks.
- D. Required to monitor blood pressure frequently to assess for hypertension.
Correct Answer: B
Rationale: A decrease in libido is an adverse effect of finasteride because of the androgen suppression that occurs with the drug. Although orthostatic hypotension may occur if the patient also is taking a medication for erectile dysfunction (ED), it should not occur with finasteride alone. Improvement in symptoms of obstruction takes about 6 months. The medication does not cause hypertension.
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The nurse working in a health clinic receives calls from all these patients. Which of the following patients should be seen by the health care provider first?
- A. A 64-year-old man who has perineal pain and a temperature of 38°C (100.4°F)
- B. A 60-year-old man who has a painful erection that has lasted over 5 hours
- C. A 62-year-old man who has light pink urine after having a transurethral resection of the prostate (TURP) 3 days ago
- D. A 23-year-old man who states had had difficulty maintaining an erection last night
Correct Answer: B
Rationale: Priapism can cause complications such as necrosis or hydronephrosis, and this patient should be treated immediately. The other patients do not require immediate action to prevent serious complications.
The nurse is conducting discharge teaching with a patient who has undergone a vasectomy in the health care provider's office. Which of the following information should the nurse include in the discharge instructions?
- A. May have temporary erectile dyfunction (ED) because of postoperative swelling.
- B. Should continue to use other methods of birth control for 6 weeks.
- C. Should not have sexual intercourse until his 6-week follow-up visit.
- D. Will notice a decrease in the appearance and volume of his ejaculate.
Correct Answer: B
Rationale: Because it takes about 6 weeks to evacuate sperm that are distal to the vasectomy site, the patient should use contraception for 6 weeks. ED that occurs after vasectomy is psychological in origin and not related to postoperative swelling. The patient does not need to abstain from intercourse. The appearance and volume of the ejaculate are not changed because sperm are a minor component of the ejaculate.
The nurse is admitting a patient scheduled for a unilateral orchiectomy for testicular cancer. The nurse notes that the patient does not talk to his partner and speaks to the nurse only to answer the admission questions. Which of the following actions is best for the nurse to take?
- A. Ask the patient if he has any questions or concerns about the diagnosis and treatment.
- B. Document the patient's lack of communication on the chart and continue preoperative care.
- C. Assure the patient's partner that concerns about sexual function are common with this diagnosis.
- D. Teach the patient and the partner that impotence is rarely a problem after unilateral orchiectomy.
Correct Answer: A
Rationale: The initial action by the nurse should be assessment for any anxiety or questions about the surgery or postoperative care. The nurse should address the patient, not the spouse, when discussing the diagnosis and any possible concerns. Without further assessment of patient concerns, the nurse should not offer education about complications after orchiectomy. Documentation of the patient's lack of interaction is not an adequate nursing action in this situation.
The nurse is assessing a 53-year-old man who has been having increasing problems with erectile dysfunction (ED) for several years and is interested in using sildenafil. Which of the following actions should the nurse take first?
- A. Ask the patient about any prescription drugs he is taking.
- B. Tell the patient that sildenafil does not always work for ED.
- C. Discuss the common adverse effects of erecogenic drugs.
- D. Assure the patient that ED is commonly associated with aging.
Correct Answer: A
Rationale: Because some medications can cause ED and patients using nitrates should not take sildenafil, the nurse should first assess for prescription drug use. The nurse may want to teach the patient about realistic expectations and adverse effects of sildenafil therapy, but this should not be the first action. Although ED does increase with aging, it may be secondary to medication use or cardiovascular disease in a 53-year-old.
The nurse is caring for a patient who had a perineal radical prostatectomy for prostatic cancer. In the immediate postoperative period, which of the following etiologies best relates to the nursing diagnosis of risk for infection?
- A. Urinary stasis
- B. Urinary incontinence
- C. Fecal contamination of the surgical wound
- D. Placement of a suprapubic catheter into the bladder
Correct Answer: C
Rationale: The perineal approach increases the risk for infection because the incision is located close to the anus and contamination with feces is possible. Urinary stasis and incontinence do not occur because the patient has a retention CASTERROR catheter in place for 1-2 weeks. A urethral catheter is used after the surgery.